Introduction Identification of a proper fixation of the posterior pelvic ring is of paramount importance in treatment of patients with vertically unstable pelvic injuries. Material and methods Outcomes of 29 patients with polytrauma and vertically unstable pelvic injuries treated at Level I Trauma Center between 2013 and 2017 were analyzed. The mean age of the patients was 34.8 ± 99 years. The severity of the injuries and patients’ condition were evaluated using Injury Severity Score (ISS), VPKh-P (MT), VPKh-SP, and Yu. N. Tsibin scales (1975) to determine the sequence of treatment and diagnostic procedures. Classification offered by Pape H. C. (2005) was used to evaluate physiological condition. The ISS score was 27.1 ± 9.9. All patients underwent computed tomography (CT) scan of pelvic for preoperative planning. Lumbopelvic transpedicular fixation (LPTF) was employed as a definitive treatment of vertically unstable pelvic ring fractures in all clinical observations. Posterior half-ring morphology, a need for decompression of the nerve roots of the sacral plexus, timing of surgery were considered to decide on LPTF configuration. Results Three-month-to-six-year follow-ups of 22 patients showed good and excellent results achieved in 72.7 % of the cases that are in line with findings reported in the literature. Discussion Biomechanically adequate method of internal fixation is the method of choice in the definitive treatment of vertical unstable pelvic injuries with the possibility of decompression of compromised neural structures. Lumbopelvic fixation with the possibility of simultaneous access for decompression of neural structures is the most optimal technique for these complicated injuries.

Introduction Severe chest injury with associated trauma to the rib cage, hemothorax, contusion of the lung, heart, ruptures of the mediastinal vessels,diaphragm is an important cause of morbidity and mortality in patients with polytrauma. Methods An algorithm for the examination and treatment of patients with severe chest trauma was developed, and new methods of treatment protected by 5 patents proposed. Results We report outcomes of 29 patients with multiple floating fractures of the rib cage which were stabilized, reduced and repaired with devices and frames developed by the authors. Discussion Less traumatic methods of costosternal stabilization of multiple chest injury have shown to be effective in stabilization of patients’ condition, improvement of pain, respiratory function properly maintaining the reduced bone.

Distal biceps brachii tendon ruptures are relatively uncommon injuries with numerous surgical exposures and methods of fixation offered for repair. The goal of surgical management is to restore the anatomic footprint of the biceps tendon on the radial tuberosity. Distal biceps fixation techniques include the use of bone tunnels in the bicipital tuberosity, tendon fixation with interference screws and cortical button that are competitive with alternative methods of suture anchors and transosseous sutures. Amplification of technical surgical aspects allows for a safer procedure, more aggressive postoperative rehabilitation and reduced recovery period for the elbow joint. Objective The purpose was to present the clinical experience and compare methods of fixation of tendon ruptures in terms of their advantages and disadvantages, implants’ effect on postoperative function recovery in a group of patients followed for three years. Material and methods A retrospective review included 20 patients with distal biceps brachii tendon ruptures that required surgical treatment. Results Positive outcomes were achieved in 19 cases (95 %). Disability period was 33.5 ± 0.5 days in a group of intellectual workers and 45.5 ± 0.71 days in physically active patients or sportsmen. Conclusion The findings showed advantages of combined tendon fixation with cortical button and biodegradable interference screw. The results of treatment were shown to rank more than twice over those achieved with suture anchors and transosseous sutures.

Introduction Tendon injury of the hand is one of the most frequent musculoskeletal disorders. Objective To improve results of surgical hand tendon repair. Materials and methods Outcomes of 86 patients with tendon injuries of the hand treated in municipal hospital № 4 in the city of Orenburg from 2005 to 2017 were reviewed. Tendons of 10 patients were microsurgically sutured using an original tendon holder. Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to assess functional results of treatment in addition to established clinical outcome measures. Results No complications were observed in patients who underwent original tendon suturing technique and they showed better functional outcomes as compared to controls. Conclusion The use of microsurgical tendon holder facilitated more precise and faster tendon suturing, less complication rate and higher functional outcomes.

Purpose The aim of this study was to evaluate the clinical and radiographic outcomes after medial open wedge high tibial osteotomy (MOWHTO) usingIlizarov fixator. Materials and Methods MOWHTO was performed on 25 knees of 24 consecutive patients. Upon radiographic assessment, alignment was shown as the femoral tibial angle (FTA). The posterior tibial slope (PTS) and the Insall-Salvati Index (ISI) were also measured. Results A visual analogue scale (VAS) improved significantly upon follow up (P less 0,001 for all). The overall mean FTA was 4.60 ± 4.30º varus preoperatively; at the last postoperative follow up, the value was 8.40 ± 2.0º valgus. The mean correction angle was 08.1 ± 2.0º. A significant increase in PTS was evident (P less 0.01) as was a significant decrease in the ISI. Conclusion The Ilizarov technique with hinges gives accurate correction and maintains stability until the osteotomy gap is completely regenerated and healed. The Ilizarov fixator increased PTS. © Bari M.M., Islam S., Shetu N.H, Rahman M., 2018

Introduction The benefits of surgical treatment of orthopaedic complications in the upper limb caused by cerebral palsy have been debated by some researchers. Secondary complications developed due to muscle spasticity and retraction are a serious obstacle to a significant improvement in healthrelated quality of life of CP patients. Objective To explore outcomes of CP patients who underwent surgical treatment at the Russian Ilizarov Scientific Centre “Restorative Traumatology and Orthopaedics” between 2014 and 2016. Material and methods Total 23 operative interventions were produced for 21 patients aged from 11 to 36 years (mean age of 16.6 years) using an authors’ technique. We used integral scales of the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). Classification systems intended for differential evaluation of upper extremity motor and functional impairment included Van Heest’s deformity assessment test, the House upper extremity assessment test and Gshwind and Tonkin classification. Results Spastic diplegia was diagnosed in 6 cases including 4 GMFCS III and 2 GMFCS IV. Manual ability was assessed as MACS IV in 3 cases and MACS V in 3. Fifteen patients with hemiparethic spastic CP underwent surgical treatment of upper limbs. Manual ability was assessed as MACS III in 4 cases, MACS IV in 8 and MACS V in 3. The use of the limb by the House’s scale showed level 1 in 2, level 2 in 5, level 3 in 10 and level 4 in 6 cases. The Gschwind and Tonkin classification for pronated forearm revealed level 1 in1, level 2 in 8, level 3 in 10 and level 4 in 4 cases. There was correlation between an extent of pronation contracture and impaired function of the thumb. Improved functional abilities of the upper limb, the cosmetic appearance and comfort with the use were recorded in all the cases. Conclusion Results of multilevel interventions on upper limbs in CP patients allow us to conclude that differential approach to the choice of technique and extent of surgery to ensure efficacious surgical treatment.

Introduction Two-stage revision arthroplasty is the "gold standard" of surgical treatment of periprosthetic infection in most domestic and foreign hospitals. This technique involves removal of implant components, debridement of the purulent focus and installation of a cement spacer which is subsequently replaced with a permanent implant after 3–9 months. Purpose To evaluate mid-term results of two-stage surgical treatment of patients with chronic periprosthetic infection of the knee and hip joints. Materials and methods Treatment outcomes of 172 patients with periprosthetic infection who underwent two-stage revision arthroplasty in the period from 2011 to 2015 were assessed. Among them, 113 patients developed infection after hip replacement and 59 patients had infected knee joint. The average follow-up period was 4 ± 1.58 years (range: 2 to 6 years). Results Out of 113 two-stage procedures of hip joint revision, 102 (90.2%) cases showed an arrest of infection. Four (3.6%) patients with recurrence of the purulent process underwent resection arthroplasty, another four (3.6%) rejected to replace the spacer with an implant, and three (2.6%) had a two-stage re-revision. Out of 60 (59 patients) procedures of a two-stage knee joint revision, infection was arrested in 50 (83.3%) cases; eight (13.4%) had recurrence and underwent knee arthrodesis. One (1.6 %) refused to replace a spacer for an implant, and one more (1.6%) had a two-stage repeated revision. Conclusions Two-stage knee and hip revision arthroplasty using a cement spacer is an effective option for treatment of chronic periprosthetic infection. It provides infection control in 86.7% (83.3% for knee and 90.2 % for hip joints) of cases in the mid-term follow-up period up to 5 years. However, the rate of re-infection remains significant and reaches 13.3 % (9.8% for hip and 16.7 % for knee joints).

Objective The purpose of the study was to explore peripheral hemodynamics in patients with femoral shaft nonunions treated with combined external fixation and intramedullary nail. Material and methods Two groups of patients were identified. Group I included 11 patients with a deformity at the apex of nonunion treated with consecutive combined osteosynthesis. Group II consisted of 15 patients with nonunions and femoral shortening treated with synchronous combined distraction-compression osteosynthesis. Methods of examination comprised duplex ultrasound of veins and paraosseous vessels at the regeneration site (HITACHI HI Vision Avius), USDG (ANGIO-PLUS, Moscow) and tetrapolar rheovasography (RVG) of lower limbs (Rheograph RGPA-6/12, Taganrog). Results and discussion Volumetric blood flow of the femur and tibia measured postoperatively with RVG showed no differences in the intact and operated limb whatever technique was applied. In all patients, major blood flow was recorded at stages of combined fixation and Ilizarov fixation, linear systolic velocity and pulsatility index were not significantly different from normal and intact limb values, hemodynamic criteria of vasoconstriction of major vessels were not identified. The steal syndrome of distal segments due to functional bypass was observed in patients with unstable metal constructs and did not aggravate after surgical treatment in Group I. Duplex ultrasound scan of the femoral shaft cortical bone showed expressed arterial and venous color map in all patients with high peripheral indices reflecting vascular tone and measuring PI = 12 ± 3.5; RI = 0.9 ± 0.1. Conclusion No significant hemodynamic changes were detected in major arteries during treatment of patients with femoral nonunions using combined techniques of external fixation and intramedullary nail. Vasodilatation of veins recorded during treatment of patients with femoral nonunions using combined techniques of external fixation and intramedullary nail was determined as a risk factor for venous thromboembolism. A local increase in the arterial and venous paraosseous blood flow was recorded at the cortical site of nonunion with combined intramedullary osteosynthesis.

Introduction Aseptic necrosis of the femoral head (ANFH) is a multifactorial disease, and genetic predisposition is one of these factors. Considering this circumstance, researchers search for identification of genetic markers of ANFH development. An objective of this research was to study the frequency of alleles and genotypes of polymorphic loci of 1377 C/T gene CALCR; -1997G/T, -1663indelT and +1245 G/T (Sp1) of gene COL1A1; -3731 A/G (Cdx2) и +283 G/A (BsmI) of gene VDR, and -13910 C/T of gene LCT in patients with ANFH and further analyze the association of the molecular-genetic markers under the study with the risk of developing this disease. Material and methods Analysis of association of alleles of genes for studying genetic predisposition to ANFH was carried out. Seven polymorphic markers in genes CALCR, COL1A1, VDR, LCT were detected by pyrosequencing method using the system of genetic analysis PyroMark Q24. Genotyping of 60 DNA samples of individuals with ANFH was conducted, frequencies of alleles and genotypes were determined. Results Genotype A/A of polymorphic locus +283 G/A (BsmI) of gene VDR (OR = 2.92; 95 % CI: 1.16–7.35) was associated with the risk of ANFH development as well as the carriage of allele A of this locus (OR = 1.55; 95 % CI: 1.02-2.37). It was also found that genotype G/G of polymorphic locus -3731 A/G (Cdx2) in gene VDR increased the risk of ANFH development more than twice (OR = 2.09; 95 % CI: 0.51-8.59); the carriage of the allele G of this polymorphic locus is associated with an elevated risk of ANFH (OR = 1.8; 95 % CI: 1.13-2.86). Discussion The results show that the analysis of the polymorphic loci +283 G/A (BsmI) and -3731 A/G (Cdx2) of VDR gene enables an early identification of persons at high risk of ANFH and, consequently, a possibility to prevent this disease. However, the involvement of certain genes in ANFH development requires further study, particularly given the sample sizes and ethnic specificity. Conclusion The risk of developing ANFH increased more than twice in the presence of genotype G/G of the polymorphic locus -3731 A/G (Cdx2) of VDR gene (OR = 2.09; 95 % CI: 0.51–8.59). Association of genotype A/A of locus +283 G/A (BsmI) of the gene of vitamin D receptor VDR with the risk of ANFH was established (OR = 2.92; 95 % CI: 1.16–7.35); it was also found that the A allele carriage was associated with an increased risk of ANFH (OR = 1.55; 95 % CI:1.02–2.37).

Introduction Until now, the rates of poor results of lumbar spinal fusion remain high. It is associated with the development of adjacent segment disease and spinopelvic imbalance. The use of lordosing transforaminal lumbar interbody fusion (cTLIF) is aimed at normalizing the sagittal profile of the operated and adjacent segments. The purpose of this study was to evaluate changes in radiological segmental parameters at the level of spinal fusion, as well as their influence on adjacent segments and spinopelvic relationships. Methods The study included 30 patients who underwent 1- or 2-level lumbar fusion using the cTLIF technique. Radiography of the lumbar spine with hip joints prior to surgery and in the early postoperative period was used in all patients. The measurements of sagittal parameters at the level of intervention, in adjacent segments, as well as of spinopelvic relations were made. Results Segmental lordosis before the surgery was 4.85 ± 8.021° (-11° to 20°), and 12.58 ± 6.031° (4° to 25°) after it, p less 0.0001; average segmental correction was 8.35 ± 6.64°. Lumbar lordosis increased from 44.97 ± 17.58° to 51.8 ± 11.61°, p = 0.01; negative correlation was found between the correction value of lumbar lordosis and the initial lordosis (r = -0.7510, p = 0.0001). There was a significant decrease in lordosis in the adjacent segment from 8.77 ± 4.57° to 6.83 ± 3.96°, p = 0.015. Spino-pelvic relations improved (PI-LL before the operation was 13.1 ± 11.022° and 7.93 ± 5.97, p = 0.018 after it). There were no significant changes in the pelvic tilt (20.9 ± 7.18° versus 19.1 ± 8.58°, p = 0.13). Conclusions cTLIF provides correction of segmental lordosis by 8° on average. In the adjacent segment, there is a significant decrease in the severity of lordosis. Improvement of spinopelvic relations is achieved due to the normalization of the lumbar lordosis pro rata to the pelvic incidence. The use of cTLIF technique does not correct the angle of the pelvic tilt.

Introduction The incidence of radicular pain that arises without a surgically significant cause of compression is 4.8–10.2 % in the structure of the "failed back surgery syndrome". Pulsed radiofrequency treatment (PRF) is successfully used for several neuropathic pain syndromes, but its effectiveness for postoperative radicular pain has not been studied sufficiently. Materials and methods Prospective non-randomized open study was performed. A group of 56 patients with postoperative radicular pain syndrome was included. Twenty-two patients of the index group underwent PRF treatment of dorsal root ganglia (DRG) in combination with transforaminal epidural steroid injection (TFES) while 34 patients of the control group received only TFES. Outcome of a successful response was defined as a 50 % reduction in numeric rating scale (NRS-11) or 4-points pain reduction and/or a 20 % decrease in the Oswestry Disability Index (ODI), and/or an 8-point decrease in the sciatica bothersomeness index (SBI) from the baseline and the effect duration for six or more months. Dynamics of the decrease in the parameters studied was assessed and compared; a search for significant prognostic factors was carried out. Results Positive results of interventions, based on specified criteria, were obtained in 18 patients (81.82 %) in the index group and in 19 patients (55.88 %) in the control group (significant difference, p = 0.045). There was a significant decrease in all indices after the intervention, a decrease in SBI in the main group was significantly lower than in the control one, p = 0.021. There were no major complications and side effects. The presence of allodynia/hyperpathy was the main negative prognostic factor in the index and in control groups with OR 0.79 at 95 % CI (0.735–0.897) and OR 0.82 at 95 % CI (0.780–0.929), respectively. Conclusion The use of the PRF in combination with TFES is an effective method in comparison with TFES alone for treatment of postsurgical radicular pain syndrome.

There is no unified system for assessing the functional mobility (lability) of the spine to diagnose its hypermobility, pathological mobility and instability. In the absence of such a system, biomechanical characteristics of spinal segments, revealed in normal individuals and by clinical examination of patients, are instrumentally and metrically incommensurable with its kinematic characteristics detected in functional radiographs. Purpose Development of criteria and methods to assess the postural function (lability) of the spine and the rigidity of its deformations for their consideration and suggestion as a metric standard Materials and methods Patients (n = 43) aged 9 to 23 years with clinical and radiological signs of spinal curvatures of grades 2 to 4 (according to Chaklin) and orthopedically healthy subjects of the same age (n = 79) were examined. Instrumental analysis of the monitored postural activity of the trunk and spine in orthostatics was carried out by the optoelectronic method KOMOT. Results and discussion It was established that the postural characteristics of spinal deformities are significantly different in sample populations in terms of expected magnitude of curvature and variability. If in postural and in sample sets the angular characteristics of spinal curves obey the law of normal distribution, then their postural variation in samples tends to a power-law type of distribution. In orthostatic position, the power-law type of the variability distribution was reliably manifested not only with respect to the angular characteristics of spinal curvatures, but also with respect to the variability of a number of other postural parameters. As a result of the analysis of the distribution of random variables characterizing the angular curves of the spine in orthostatic stereotypes and the dependencies between their variation and the expected values in sample populations, a quantitative topographic evaluation of the functional mobility of the spine according to the index of postural lability (IPL) was proposed. Conclusion To adequately assess the postural function of the spine (its lability), it is necessary to have not only a single-stance recording of the parameters under study but to repeatedly register them in a feasible prolonged examination. Only mathematically expected values and root-mean-square deviations of angular parameters reflect more fully the state of spinal curvatures and have the necessary and sufficient diagnostic information. A quantitative topographic estimation of the functional mobility of the spine according to index of postural lability (IPL) is suggested. Normally, IPL is in the range of 30 to 75 %. If the index is less than 30 %, the spine is hypermobile; if it is more than 75 %, the spinal column is rigid.

Introduction Despite a great number of researches on idiopathic scoliosis reported there is still no instrumentation assessment of sensitivity before and after surgical correction of the curve found in literature. The purpose of the work was to explore dynamics in thermal pain sensitivity following correction of severe and mild spinal curves in patients with idiopathic scoliosis. Material and methods The work included results of examination of 25 patients with idiopathic scoliosis. Sampling population was divided into two groups depending on the extent of preoperative curve in major arch: Group I included patients with the curve of ≤ 60º (15 cases); Group II consisted of patients with the curve of > 60º (10 patients). Preoperative neurological examination showed no motor, reflex and sensory impairments. Acute deformity correction and spine stabilization with transpedicular systems were produced in all the cases. Thermal pain sensitivity was explored preoperatively and postoperatively at Th1-S2 dermatomes using electric esthesiometer. Results Disturbed thermal pain sensitivity of various extent was observed preoperatively in the study dermatomes of all patients with idiopathic scoliosis and was not shown to be dependent on the amount of the curve. Positive dynamics in thermal pain sensitivity revealed itself in reduced pain and heat thresholds and restored heat sensitivity and was observed in 41.5 to 54.1 % of the cases Group I following spine deformity correction. Deterioration was seen in 29.2 to 34.7 % of the cases. Group II showed negative dynamics in thermal pain sensitivity in 35.4 to 50 % of the cases with either increased or decreased pain threshold, enhanced heat threshold and loss of heat sensitivity. Sensitivity improved in 29.4 to 31.8 % of the patients. No changes in neurological status were noted in both groups after surgical correction with subclinical changes in thermal pain sensitivity to be considered. Conclusion Positive dynamics in thermal pain sensitivity prevailed in patients with idiopathic scoliosis following baseline curve correction of ≤ 60º. Negative dynamics in thermal pain sensitivity was seen in patients with baseline curve correction of > 60º with a greater risk of neurological complications.

Introduction Along with expansion of the types of metal implants and indications to osteosynthesis with their application, contemporary operative traumatology continues to meet with such a complication as metal fixator breakage. The frequent cause of fixator failure is an incorrect osteosynthesis or an improperly chosen implant. Quite often, the cause of the complication remains unknown. The purpose of our study was to establish the need for spectral analysis in assessing the cases of metal fixator collapse after osteosynthesis of long bones as well as to determine the rate of the composition defects of the implants used for osteosynthesis of limb bones. Methods We performed a spectral analysis of 16 broken implants extracted from 15 patients operated on in Semashko Hospital, State Hospital No. 17 and State Hospital No. 68. The group included metal implants for both intra- and extramedullary osteosynthesis. Results Of the 16 implants studied, five (31.25 %) complied completely with the requirements of the standard, two stainless steel and three titanium metal implants among them; eleven implants (68.75 %) did not meet the international standards. Discussion In a number of cases (for example, with stainless steel implants) the deviations were significant; variability of the alloys was also noted in titanium implants. Because these deviations in composition may play a role in the destruction of metal fixators, we believe that such a study as spectrography should be recommended for the analysis of cases of implant breakage.

Traumatic injuries to the sternoclavicular joint (SCJ) dislocations account for less than 3% of all joint dislocations. However, instrumentation fixation is frequently associated with high-risk complications that lead to disability. The authors sought to explore historical aspects of various surgical fixation techniques based on specific anatomy of injured segment. The findings are presented in the chronological order briefly describing methods of fixation, the authors and clinical results obtained.

Introduction Incidence of adult degenerative scoliosis (ADS) among individuals over 50 years old reaches 68%. Surgical interventions aimed at correcting the spinal deformity in patients of the older age group are accompanied by a high risk of complications. The use of LLIF is associated with lower complications as compared with open anterior or posterior fusion. Materials and methods Seventy-one patients with ADS (13 men, 58 women) were operated at the Federal Neurosurgical Center. Their average age was 60.4/60 (average/median) [55;64.5] (1: 3 quartile) years. The follow-up was from 12 to 18 months. X-ray study, SCT, MRI of the lumbar spine were used. Questionnaire surveys were conducted using the visual analog pain scale (VAS), Oswestry Disability Index (ODI) and the Short Form-36 (SF-36). Deformity correction was estimated in the frontal plane with Cobb’s method. Scoliosis was classified according to SRS-Schwab classification. Parameters of sagittal balance were estimated: PI (Pelvic incidence), SS (Sacral slope), PT (Pelvic tilt), LL (Lumbar lordosis). SVA, PT and PILL (PI minus LL) were defined adjusted for the age. Results Back pain according to VAS relieved from 6.1/6 [4;8] to 2.2/2 [2;3] points (p less 0.001) and was statistically significant at 12 months after the surgery. Leg pain according to VAS decreased from 5.4/5 [4;8] to 2.1/2 [1;3] points (p less 0.001) and was statistically significant at 12 months after the surgery. Functional adaptation according to ODI improved from 51.2/52.2 [38.6;64.1] to 31.8/33.3 [26.1;35.9] (p less 0.001). According to SF36, PH before the surgery was 25.7/24.3 [21.8;28.9] on average and at 12 months after the surgery - 38.7/38.7 [35.4;41.2] (p less 0.001). SF-36 MH before surgery was 27.1/26.3 [21.8;31.4] on average and 12 months later – 41.3/40.6 [36.5;43.7] (p less 0.001). PT before the surgery was 23.3/22° [17.5;28], 12 months later it was 17.9/17° [15;20] (p less 0.001). PI-LL was 11.5/10 ° [4;17.5], 12 months later – 8.4/8 ° [5.5;11.5] (p = 0.11). Transient paresis of femur flexors on the ipsilateral side was observed in five (7 %) cases; transient hyposthesia on the anterior thigh surface occurred in eight (11.2 %) cases. There were two cases of medial malposition (0.4 %) of pedicle screws (474 screws), pseudoarthrosis at two levels (1.2 %) (Grade 4 Bridwell) out of 166 levels performed, and seven (4.2 %) cases of damage to cortical endplates. Conclusion Restoration of local sagittal balance in ADS patients by short-segment fixation using LLIF technology leads to a statistically significant improvement in the quality of life and increases functional adaptation. Few early and late postoperative complications, less intraoperative blood loss and shorter hospital stay make LLIF in combination with MIS transpedicular fixation a method of choice in determining the surgical tactics for ADS in elderly and old age patients.

The treatment result in a patient with a complex deformity of the feet due to neural Charcot-Marie-Tooth amyotrophy is presented in the article. A combined use of the Ilizarov transosseous osteosynthesis method and transfer of the tibialis posterior muscle tendon by anchoring to the cuboid bone allowed us to achieve a successful long-term result of treatment and restore ability of active dorsiflexion of the foot. Functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale. AOFAS score increased significantly from 26 points preoperatively to 80 points at 18 months after intervention. The ankle motion increased from 25° preoperatively to 50° on the left side and 60° on the right side at long term. In our opinion, this approach allowed the patient to start walking earlier, restored weight-bearing ability of the foot and reduced treatment time.